Relevance of Interprofessional Education for HIM Professionals

By Karima H. Lalani, MBA, RHIA, and David L. Gibbs, PhD, CPHI, CHPS, CPHIMS, CISSP

The practice of “interprofessional education” (IPE) is growing in importance across all healthcare disciplines, including health information management (HIM), and impacts both HIM education and practice. The rise of interprofessional education coincides with the expanding scope of HIM practice, creating a fantastic opportunity for HIM practitioners to reintroduce our profession to other members of healthcare teams. Do the clinicians in your workplace fully understand HIM’s expertise with information governance, privacy and security, health informatics, and data analytics? For example, do your clinicians come to you with questions about clinical documentation improvement, or do they engage you to help increase productivity with electronic health records (EHRs)? Does your information technology department come to you about validation of patient-related data and involve HIM in the design of health information exchange solutions? If the answer is no, an interprofessional education program is a viable solution to educate other healthcare areas and departments about the specific value of HIM’s work.

The landmark 1999 report from the US Institute of Medicine To Err is Human: Building a Safer Health System identifies patient safety as an essential element of quality healthcare, which in turn impacts patient outcomes. In today’s environment, patient outcomes are increasingly dependent upon accurate and timely health information at the point of care, so involving experts in HIM can help improve clinical decisions. Interprofessional education across healthcare areas provides an opportunity to educate others in the workplace about the capabilities of today’s reimagined HIM professionals in improving patient outcomes. Rather than simply telling clinicians about the various capabilities of HIM, professionals should demonstrate the benefits of HIM involvement. For example, many healthcare organizations facilitate training among patient care teams to improve patient safety through communication and teamwork exercises. Involving HIM representatives in the training along with clinicians would reinforce the important roles of HIM and facilitate opportunities for the HIM team to demonstrate abilities.

Although the definition of interprofessional education has been highlighted before, it is worth repeating because it is easily misunderstood.¹ The World Health Organization (WHO) defines interprofessional education as occurring when learners “from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”² It is important to emphasize that interprofessional education occurs when participants from different disciplines learn from and with each other, so a guest presenter from another discipline does not meet the definition—the learners must interact with each other. The collaboration among the learners may occur in the workplace, in a classroom, or in other settings. Also important in the interprofessional education definition is the objective of improving health outcomes, which extends the impact of the initiative beyond education and into practice. WHO points out “interprofessional healthcare teams understand how to optimize the skills of their members, share case management and provide better health-services to patients and the community.”³ Healthcare delivery is continuously evolving, and healthcare organizations are under constant pressure to improve patient outcomes, manage costs, and improve patient experiences.

To tackle today’s healthcare challenges, interprofessional education provides needed exposure of HIM’s evolving capabilities to other healthcare professionals enabling collaborative practice. For example, at Texas State University, nursing students engage with EMS and police departments to simulate mass casualty events. Perhaps HIM students can become involved to simulate events where patient information on a mass scale is affected, like in a flood or a hurricane. As EHR systems are increasingly used to inform clinical decisions in real time at the point of care, HIM practitioners are responsible to ensure the EHR systems deliver the right information to the right clinicians at the right time. HIM practitioners should also collect feedback from clinicians to continually improve the effectiveness of EHR workflows and configurations. Directly supporting clinicians to collaboratively optimize EHRs and other health informatics systems is a great way to demonstrate the capabilities of HIM and allow other members of the patient care team to focus on the patient.

The Institute of Medicine noted in its 2001 report that the US healthcare system lacks consistency in delivering quality care to everyone and mentioned in its “Ten Rules for Redesign” that collaboration and communication amongst healthcare providers should be a priority to ensure proper coordination of care and appropriate exchange of information about patients.⁴ With the HIM profession continuously evolving along with the rest of the healthcare field, it is imperative to focus energy toward maintaining the HIM profession as an integral part of healthcare delivery teams—and interprofessional education can help with this objective.

Interprofessional Education Applications

The authors of this article were inspired by earlier works on interprofessional education in the Journal of AHIMA⁵ and found additional encouragement in AHIMA’s Code of Ethics, which states that HIM professionals shall “facilitate interdisciplinary collaboration in situations supporting health information practice.”⁶ In April 2017, the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) became a member of the Health Professions Accreditors Collaborative (HPAC)—demonstrating a commitment to advance interprofessional education. Based on these foundations, the authors encourage HIM practitioners to proactively engage as active participants in patient care teams of clinicians and administrators to optimize patient outcomes, such as by reducing medical errors, and to promote the broad capabilities of HIM professionals to deliver critical health information in real time at the point of care for clinical decision making.

To facilitate collaboration among healthcare professionals, the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ) developed “Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS),” which was released in 2006.⁷ TeamSTEPPS is an evidence-based framework designed to improve quality, safety, and efficiency of healthcare through optimizing the use of information, people, and resources. The TeamSTEPPS framework consists of four skills: leadership, situation monitoring, mutual support, and communication. Participants in TeamSTEPPS training learn or reinforce effective communication skills to effectively share critical health information among the care team. For example, the common technique of structuring clinical conversations with the framework of situation, background, assessment, and recommendation (SBAR) is demonstrated and practiced. HIM practitioners would benefit from exposure to how health information is communicated verbally among the care team. Likewise, clinicians would benefit from deeper understanding of the role of HIM professionals to manage the health information and deliver it when and where needed. TeamSTEPPS is widely used in clinical and academic settings to enable interprofessional education and provides an excellent opportunity to raise awareness about the capabilities and roles of HIM professionals.

A program that is effectively utilizing interprofessional education in a way that is specifically relevant to HIM professionals is the University of Kansas Medical Center. Students in doctorate of nursing practice, dietetics and nutrition, occupational therapy, pharmacy, and HIM programs were placed on interprofessional teams to complete a simulation scenario. Each member of the team contributed to the patient’s care and helped educate their peers. The HIM students reviewed clinical documentation created by students in each profession to determine the quality of documentation from the perspective of reimbursement as well as from the perspective of the “meaningful use” of EHRs. Feedback from HIM students was acknowledged to improve documentation, which would benefit future clinical decisions as well as billing. In other scenarios, HIM students observed clinical teams at work and provided feedback to improve processes and manage risks.⁸

An interprofessional education research study at the University of Southern Indiana’s Department of Nursing brought together students from health informatics, nursing, and radiologic technology departments to build an academic patient electronic health record using a fictitious case study.⁹ The study’s findings showed improvement in students’ understanding of healthcare team roles and analysis of patient data, which occurred through effective use of informatics systems, including EHRs. The participants increased their knowledge, skills, and abilities with informatics systems as well as applied strengths of each discipline to develop a patient-centered plan of care. The study concluded that students augmented their understanding about data entry, analysis, and application through their interprofessional exercise.¹⁰

The white paper “HIM Reimagined: Transformation Starts With You” highlights that HIM professionals are members of increasingly collaborative and interdisciplinary patient care teams, which improve healthcare outcomes and reduce costs.¹¹ One of the critical drivers for interprofessional practice is effective sharing of health information. As experts in managing health information, HIM professionals must be an integral part of the patient care teams. To prepare for collaborative practice, we must begin with collaborative education.

Academic programs for numerous healthcare professions are incorporating interprofessional education into accreditation requirements, underscoring its importance. Accrediting bodies for the professions of medicine, dentistry, pharmacy, psychology, nursing, physical therapy, occupational therapy, and public health all have requirements for effective participation on interprofessional teams.¹² Is it time for HIM programs to add interprofessional education activities to the curriculum? One benefit of incorporating interprofessional education into HIM programs is that students of other health professions will learn the value and expertise HIM professionals bring to the patient care team before entering the workforce.

The practice of healthcare is continuing to evolve towards more integrated delivery of care. At Texas State University, students from two or more disciplines are beginning to share educational activities when possible. For example, HIM students joined health administration students to collectively participate in a seminar about artificial intelligence and data analytics. Faculty in respiratory care and physical therapy are planning an interprofessional education activity where students from both programs learn together about pulmonary conditions and treatments, as well as the boundaries of their respective roles. Given their strong accreditation requirements for interprofessional education, nursing faculty are proactive in developing interprofessional opportunities for all our students in healthcare professions.

Bringing students from two or more programs together is challenging. There are logistical issues of time and place. There are also issues with finding time in the curriculum to incorporate interprofessional education. Ideally, faculty from two or more academic departments will collaborate to identify topics of mutual interest which occur at times that are conducive for aligning student schedules. Student-led activities may be created to achieve the interprofessional education requirements for students to learn about, from, and with each other. Guest lectures by faculty from another department do not constitute interprofessional education; students must collaborate with each other.

Recommendations for HIM-Based Interprofessional Outcomes

With the HIM profession continuously evolving, it is imperative to focus energy towards maintaining the profession as an integral part of healthcare delivery teams. Educating others on the care team about the evolving and expanding abilities of HIM professionals is an important part of this effort. The authors of this article propose the Awareness, Integration, Creation (“A-I-C”) model (see Figure 1 below) and make recommendations about the opportunities presented by interprofessional education both in the workplace and in academic programs. This A-I-C model can be used as a framework to help practitioners and educators raise awareness of the need for interprofessional education, identify existing opportunities, and develop new activities when necessary. Interprofessional education does take some effort but may help enable and accelerate HIM professionals to be effective members of patient care teams.

Recommendations for HIM Practitioners

With the continually evolving nature of the HIM profession, HIM professionals need to strive for continuous integration within the respective healthcare teams at their facilities and must take a proactive stance towards interprofessional education. HIM practitioners can apply the A-I-C model toward this goal (see Figure 2 below).

Awareness of interprofessional education opportunities for HIM roles is the first step and an ongoing activity. HIM professionals should strive to create awareness among other healthcare professionals of their respective roles so that the HIM department is not sidelined. Interprofessional education is especially applicable in raising awareness of HIM among other healthcare professions, and the education should take place at the staff-, management-, and upper management-level.

Integration with existing interprofessional education activities is the second step. HIM professionals should engage with existing patient care teams and in staff training events and other interprofessional activities. HIM must be proactive to represent the HIM discipline on patient care teams and in staff training events to enable and improve the information driving clinical and business decisions.

Creation of interprofessional education activities becomes an appropriate third step, if interprofessional education has not yet begun at a healthcare organization. For example, the EHR has become a common tool spanning almost all clinical and administrative roles in healthcare. HIM professionals should have expertise with their local EHR system; they can use this expertise to engage other professionals and departments as a resource on EHR use. One opportunity to create interprofessional education activities is to host a lunchtime training session covering appropriate topics of the organization’s EHR.

Another opportunity is to proactively publish data quality improvement reports about the EHR and new features available in the system. HIM could publish a newsletter or create an internal company webpage to highlight research recently conducted on local EHR data. HIM could also conduct regular webinars to highlight the importance of information governance and its relationship to patient and business outcomes of the healthcare organization. These activities can accomplish the interprofessional education objective while also demonstrating HIM capabilities of data analytics and information governance. Engaging with patients and families during a healthcare encounter—not only before and after—also reinforces HIM’s role on the patient care team.

Recommendations for HIM Educators

HIM educators can apply the A-I-C model toward interprofessional education initiatives as shown in Figure 3 below. While all phases of the A-I-C model may be applied at all HIM educational levels, there are practical constraints related to the maximum number of program hours and required content for accreditation. It may be most appropriate for associate-level HIM programs to focus on awareness, while baccalaureate programs strive to achieve awareness and integration with interprofessional education activities. Master’s degree programs may have the most flexibility to create new interprofessional education activities. All levels of activity are dependent upon availability of other academic disciplines and cooperating faculty.

Figure 3: Awareness, Integration, Creation (A-I-C) Model for HIM Educators

HIM professionals should seek out and be aware of any existing interprofessional education activities in their academic institution. Awareness is the first step and has no cost. Educators should also integrate HIM into existing activities—leveraging existing opportunities may have little cost or impact on curriculum. For example, if nursing students are learning about writing progress notes around the same time when HIM students are learning to audit and correct clinical notes, create an activity for students from both disciplines to collaborate and practice together. Cross-discipline homework assignments may require only minimal coordination between faculty members. Educators should also create new interprofessional education activities around HIM, when necessary, and leverage the TeamSTEPPS framework, if possible, to ensure HIM students are represented.

HIM educators should begin with interprofessional education activities involving students from HIM and one other discipline to keep the logistical challenges manageable. Add more disciplines to increase the collaboration and benefit over time, if appropriate, at your academic institution. TeamSTEPPS was used at the University of Kansas and is being used at other institutions, including Texas State University. Faculty from the nursing and physical therapy programs at Texas State University became TeamSTEPPS Master Trainers and facilitated interprofessional awareness activities for students and faculty.

One of the first activities took advantage of an existing event which brought together Texas State University students from all healthcare disciplines across the college. The dean sponsors an annual Scroll Ceremony to welcome students recently admitted into the healthcare professional programs. Originally, this event was ceremonial and brief, but the ceremony was extended at the request of the college interprofessional education committee to incorporate activities that enabled the assembled students to learn about, with, and from each other. For example, students from each discipline were shown in a video describing how their profession contributes to the healthcare delivery team. The video was intended to inspire awareness and ongoing discussion among students about each other’s profession. The students were organized into small groups, ensuring each discipline was represented. The groups were then given simple problems to solve which required them to communicate effectively in difficult situations. This event served as an ice breaker among the incoming students, which helped streamline interdisciplinary assignments throughout their education programs.

Interprofessional Education Leads to Better Patient Outcomes

As the HIM profession continues to evolve with increased emphasis on information governance, data analytics, and health informatics, HIM professionals have the opportunity and responsibility to ensure professionals in other healthcare disciplines are fully aware of the capabilities of HIM. Instilling awareness of and appreciation for the various HIM roles in practice and during academic preparation will lead to better collaboration among healthcare teams and better outcomes for patients. Integration with existing interprofessional education events, and creation of new activities are additional ways in which HIM professionals can continue to demonstrate their value and leverage their expertise.

Notes

1. O’Dell, Rosann M. et al. “Breaking Down Healthcare’s Silos: University of Kansas Medical Center’s Interprofessional Education Fostering ‘HIM Without Walls.’” Journal of AHIMA 86, no. 9 (September 2015): 26-29.
2. World Health Organization. “Framework for Action on Interprofessional Education and Collaborative Practice.” 2010. www.who.int/hrh/resources/framework_action/en/.
3. Ibid.
4. Institute of Medicine. “Crossing the Quality Chasm: A New Health System for the 21st Century.” March 2001. www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf.
5. O’Dell, Rosann M et al. “Breaking Down Healthcare’s Silos…”
6. AHIMA. “AHIMA Code of Ethics.” October 2, 2011. http://bok.ahima.org/doc?oid=105098.
7. Agency for Healthcare Research and Quality. TeamSTEPPS. www.ahrq.gov/teamstepps.
8. O’Dell, Rosann M et al. “Breaking Down Healthcare’s Silos…”
9. Titzer, Jennifer L., Constance F. Swenty, and Gabriela Mustata Wilson. “Interprofessional education: Lessons learned from conducting an electronic health record assignment.” Journal of Interprofessional Care 29, no. 6 (2015): 536-540.
10. Ibid.
11. AHIMA. “HIM Reimagined: Transformation Starts with You.” www.ahima.org/about/him-reimagined/himr?tabid=whitepaper.
12. Zorek, Joseph and Cynthia Raehl. “Interprofessional education accreditation standards in the USA: A comparative analysis.” Journal of Interprofessional Care 27, no. 2 (2012): 123-130.

Karima H. Lalani (KL32@txstate.edu) is senior lecturer, department of health information management, and David L. Gibbs is assistant professor, department of health information management at Texas State University.